Bleeding during pregnancy

Bleeding during pregnancy probably initially causes a shock and concern for most expectant mothers about their baby. Especially in the first weeks of pregnancy, bleeding is not uncommon and, fortunately, usually not a cause for concern – nevertheless, it should always be taken seriously to rule out more serious reasons. In this article, you will learn about potential triggers behind bleeding during pregnancy and when you should see your doctor.

What are the causes of bleeding during pregnancy?

The possible causes vary throughout pregnancy, which is why a distinction is made between bleeding in early and late pregnancy. In the first trimester, about one in four women experiences light spotting. The pulling sensation can resemble menstrual cramps, and some women may not even realize they are pregnant. Therefore, bleeding in early pregnancy is often mistakenly confused with a period — however, a period cannot occur during pregnancy.

Possible causes in early pregnancy:

Even if they can scare you, bleeding in early pregnancy is often caused by harmless reasons:

• implantation bleeding ( Nidationsblutung ): Between the 7th and 12th day after fertilization, you may notice a brief light red bleeding. At this time, the fertilized egg implants in the uterus and may cause small blood vessel injuries.

• Hormonal change: Some women experience a temporary corpus luteum insufficiency at the beginning of pregnancy, meaning the level of the corpus luteum hormone progesterone is too low. As a result, spotting may occur. If the hormone levels do not regulate themselves after some time, your doctor may prescribe compensatory progesterone. Corpus luteum insufficiency is one of the most common causes of spotting in early pregnancy and can be easily and effectively treated with progesterone administration.

• Cervical polyp: This benign tumor on the cervix can cause bleeding during (early) pregnancy. A cervical polyp is usually harmless but should be monitored throughout the pregnancy.

• Infections of the vagina or cervix: Bleeding caused by infections is initially harmless for the pregnancy and your baby. However, you should still have it treated, as it can, in the worst case, lead to premature labor.

• Ektopie: An ectopia is a protrusion of the uterine lining onto the cervix. It is painless, and the bleeding that can be caused by it is also harmless. If you suffer from an ectopia, it is usually known before pregnancy. Because the mucous membrane is more heavily blooded during pregnancy, the protrusion is usually intensified.

• Contact bleeding: During pregnancy, your entire tissue is better supplied with blood. During the Sexueller Kontakt or during vaginal examinations, it may therefore be easier to cause small vascular injuries, which become noticeable through red or slightly brownish spotting.

• Blasenentzündung oder Hämorrhoiden: Burst Hemorrhoids or a bladder infection can lead to blood in the stool or urine and can sometimes be mistaken for bleeding from the vagina. However, they have nothing to do with pregnancy and do not affect it. Nevertheless, you should always consult your doctor if you discover blood in your stool or urine. Especially bladder infections should be treated during pregnancy to prevent a vaginal infection from developing as a result.

In other cases, also serious causes are caused by bleeding in early pregnancy:

• Ectopic pregnancy: The fertilized egg mistakenly implants in the fallopian tube (in the vast majority of cases), in the ovary, in the abdominal cavity, or in very rare cases in the cervix instead of the uterus. The surrounding tissue is damaged by the growing embryo, leading to painful, sometimes stabbing spotting. In the case of an ectopic pregnancy, internal bleeding into the abdominal cavity can also occur, which can become extremely dangerous and should be treated medically as quickly as possible.

• Ovarian cyst: If a cyst bursts, surrounding blood vessels can be damaged. It can cause severe internal bleeding, which is not only painful but can also endanger the pregnancy.

• Miscarriage: One Miscarriage can have various causes. Some of them, but not all, can lead to more or less severe bleeding and/or lower abdominal discomfort.

Since bleeding during pregnancy always requires caution and there is a medical suspicion of a (threatened) miscarriage, you should always see a doctor if you notice bleeding.

Possible causes in the second half of pregnancy (after the 20th week of pregnancy):

In the second half of pregnancy, bleeding occurs significantly less frequently than in the first. Even after the 20th week of pregnancy, relatively harmless triggers can be behind the bleeding:

• Contact bleeding: For example, after sexual intercourse or a vaginal examination.

• Blasenentzündung oder Hämorrhoiden: Even in the second half of pregnancy, blood in the urine or stool with bleeding from the vagina can be confused. They do not directly affect the pregnancy, but should still be treated by a doctor in any case. A bladder infection, for example, can lead to an infection if left untreated.

• Cervical polyp: Even later in pregnancy, this harmless tumor on the cervix can cause bleeding.

However, bleeding in the second half of pregnancy often has a more serious cause than in the first half:

• Premature placental abruption: If the placenta detaches prematurely from the uterine wall, for example as a result of severe abdominal trauma, it can lead to heavy, painful bleeding. Depending on the extent of detachment, the baby's supply may no longer be guaranteed, and a cesarean section may be necessary.

• Uterine rupture: Even tearing the uterine wall (or rupturing it) leads to painful bleeding and can be life-threatening for both mother and child. However, this does not happen spontaneously, but usually during labor when the uterus is already weakened, often due to previous surgeries.

• Late miscarriage, early or stillbirth: The probability of a Miscarriage decreases significantly during the course of pregnancy. Unfortunately, in rare cases, a miscarriage, preterm birth, or stillbirth can still occur in the second half of pregnancy. These bleeding episodes are accompanied by strong, labor-like pains and loss of amniotic fluid.

• Placenta previa: If the placenta is positioned over the cervix, it can lead to painless, sometimes heavy bleeding and mild contractions, for example after exertion or sexual intercourse. Depending on whether the bleeding persists, a cesarean section may be necessary. In other cases, the expectant mother will be transferred to the hospital for monitoring or advised to rest as much as possible at home.

• Drawing bleeding: These are light bleeding that can indicate an upcoming birth – possibly accompanied by the loss of the mucus plug. After the 37th week of pregnancy, when your baby is considered mature, this bleeding is completely harmless. However, before this time, it can indicate a premature birth.

When should I see a doctor for bleeding?

Most often, the cause of bleeding during pregnancy is not immediately apparent. Therefore, you should in any case as quickly as possible have a medical examination to determine whether the bleeding is caused by harmless or more serious factors that require treatment. It is best to contact your doctor, hospital, or go directly to the emergency room in case of an emergency.

How are the bleeding episodes treated?

First, the cause of the bleeding will be investigated. Your doctor will ask you about the severity of the bleeding, its occurrence, and any possible pain. During a vaginal (ultrasound) examination, they will check whether the blood is actually coming from the uterus. Subsequently, the placenta will be examined with another ultrasound to assess its location and any possible hematomas. From the second trimester onwards, a cardiotocography may also be performed to monitor your baby's heartbeat and circulation over a longer period.

It turns out that harmless causes are the trigger for the bleeding and your pregnancy is not affected by it, still give yourself and your body plenty of rest and avoid stress. If your doctor advises you to do so, you should also refrain from sexual activity for the time being.

If more serious reasons are behind the bleeding, further treatment depends on the exact diagnosis. If the bleeding persists or is very heavy, it must be stopped initially. This is to prevent the supply of your child, as well as your own, from being compromised by blood loss. During an examination at your gynecologist's practice, she/he may arrange for an immediate (supine) transport to the nearest hospital, where you and your baby can be closely monitored and further measures can be taken. If a miscarriage is imminent, this may involve administering labor-inhibiting medications and bed rest. In case of complications in the second half of pregnancy, such as placenta previa, premature uterine rupture, or premature placental abruption, an emergency cesarean section may also be necessary.

More than half of all pregnancies with light bleeding in the first trimester develop normally afterward. However, the likelihood of preterm rupture of membranes and preterm labor is slightly increased after previous bleeding. But don’t let that unsettle you: your doctor will monitor you even more closely if you experience bleeding during pregnancy, so that you can hopefully experience and enjoy the rest of your pregnancy without further scares. We wish you all the best!